| NPI | 1740307073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IN 01065989A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 243214) |
| 207N00000X Dermatology (Licence: CA BA9238610) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 243214) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA BA9238610) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 243214) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA BA9238610) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2009-02-05 |